Consequence of ANASTROZOLE on Chemo therapy

Case Report | DOI: https://doi.org/10.31579/2640-1053/013

Consequence of ANASTROZOLE on Chemo therapy

  • Saritha Garrepalli 1*
  • Stefano Cattaneo 1
  • 1* Department of chemotherapy.

*Corresponding Author: Saritha Garrepalli, Department of chemotherapy

Citation: Saritha Garrepalli, Stefano Cattaneo. Benign Breast Lumps. J Cancer Research and Cellular Therapeutics, Doi: 10.31579/2640-1053/013

Copyright: © 2017 Saritha Garrepalli . This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 30 June 2017 | Accepted: 20 August 2017 | Published: 04 September 2017

Keywords: fourier transform ; PEGylated Anastrozole-BSA ; colon cancer

Abstract

Prepared nanoparticles were characterized in terms of particle size, scanning electron microscope (SEM), fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). In-vitro release studies were performed in phosphate buffer saline pH 7.4 at 37˚±0.5˚C for 1month. The mean particle size of obtained nanoparticles was 150-400 nm and was apparently spherical in shape, with smooth surface. DSC is done for the stability test for pure drug and sample. The thermogram of drug has not shifted for in the formulation compare to pure drug thermogram hence, the stability of  formulation is not changed. FT-IR studies demonstrated that the drug was not changed in the formulation during the fabrication process.The encapsulation efficiency was about 48%. The Anastrozole-BSA nanoparticles exhibit a most interesting release profile with small initial burst followed by slower and controlled release.

Cancer

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.The terms cancer, malignant neoplas,and malignant  tumour  are synonymous.

Cancer is a diseases characterised by un contrlled growth and spread of abnormal cells,which can result in death.Apoptosis is the process of programmed cel death (PCD)that may occur in multicellular organisms. Biochemical events leads to characteristic cell changes (morphology)and death. These changes include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation. Generally cancer cell deviate the apoptosis process.

The national cancer act was passed in 1971. The cancer is a more than 100 different types.Mostly cancers are named for the organ or type of cell in which they start  for example, cancer that begins in colon is called colon cancer ,cancer that begins in melanocytes of the skin is called melanoma.  

Cancer, while the second leading cause of death in the United States, is not just one disease. It's a condition in which cells break the most fundamental rules of behavior. For any number of reasons, cancer cells fail to repair damaged DNA, they reproduce without restraint, colonize other tissues in the body and ignore signals telling them to self-destruct. The causes and consequences of cancer differ from type to type, and from patient to patient. On a molecular level, rarely are any two cancers exactly the same.

More than 50% of this cancer occur in  5major organs like lungs,colon,rectum,breast,prostate and uterus. Cancer of lungs colon,and prostate are the principle leading causes of death in males. Where as breast and uterus cancer are most cammon in females.

Background

The word cancer  is derived  from the latin word. Cancer is a popular and generic word, as the actual medical name for cancer is a “neoplasia”, which is derived from a greek word, which means “new formation” the oldest known description and surgical treatment of cancer was discovered in egypt and dates back  to approximately 1600 B.C. Cancer is a poison  that slowly spreads and concludes  as contagious.

 The first cause of cancer was identified by british surgeon percivall pott in 1775. In 18th  century, it was discovered that the primary tumor spreads through the lymph nodes to other sites(metastasis).the use of surgery to treat cancer had poor results  due to problems with hygiene. In 19th century, improved surgical hygiene and surgical removal of the tumor became the primary treatment for cancer.

 The age of cellular pathology was born. At the end of 19th century, radiation therapy,non surgical cancer treatment  was adopted. Since world war 2, trends in cancer treatment were to improve on a micro level the existing treatment methods, standardze them,and globalize them as a way to find cures through epidemiology and international patnerships. This Neoplasia is a two types  one  is  a benign neoplasm and malignant neoplasm

Epidemiology

Cancer has projected to become the leading cause of death worldwide, according to a new edition of the world cancer report from the International Agency for Research on Cancer. Cases of cancer doubled globally between 1975 and 2000, will double again by 2020, and will nearly triple by 2030, says the report. There were an estimated 12 million new cancer diagnoses and more than 7 million deaths worldwide this year. The projected numbers for 2030 are 20 to 26 million new diagnoses and 13 to 17 million deaths31.

In the developed countries cancer is the second leading cause of death accounting for 21% (2.5 million) of all mortality. In the developing countries cancer ranks third as a cause of death and accounts for 9.5% (3.8 million) of all deaths. Cancer has become one of the ten leading causes of death in India6. It is estimated that there are nearly 2.5 million cancer cases at any given point of time. Over 8 lakh new cases of cancer and 4 lakh deaths occur annually due to cancer. Nearly 15 lakh patients require facilities for diagnosis, treatment and follow up at a given time32.

Diagnosis

Most cancers are initially recognized either because signs or symptoms appear or through screening. They do not give definitive diagnosis and requires the opinion of pathologist, a physician who specializes in the diagnosis of cancer and other diseases. People with suspected cancer are investigated with medical tests which include blood tests, X-rays, CT scans and endoscopy. The diagnosis of malignancies must be confirmed by histological examination of the cancerous cells by performing biopsy which gives information regarding the type of cell that is proliferating, its histological grade, genetic abnormalities, and other features of the tumor. cytogenetics and immunohistochemistry are other types of tests which provide information regarding molecular changes happened and also indicate the future behavior of the cancer cells33

Pathophysiology

1.Mechanism of Metastasis

The mechanism of metastasis involve primary tumor, proliferation & angiogenesis, detachment and invasion of the circulation, transport to a distant site, arrest, adherence to and extravasation through vessel wall, establishment of a microenvironment.

2. Formation of the primary tumor                          

 Tumor cells invade stroma and communicate with stromal cells. Tumor is avascular. Both tumor and host cells promote metastasis by activating growth factor pathways, allowing invasion, and promoting angiogenesis. Tumors inhibit metastasis by being antigenic and by inhibiting angiogenesis. Host cells inhibit metastasis by putting up tissue barriers, sending immune cells to kill tumor, and inhibiting angiogenesis.

3. Progressive growth and angiogenesis 

Angiogenesis occurs when tumors secrete angiogenic agents such as vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) and by their recruiting lymphocytes and macrophages to secrete these agents as well. The capillary basement membrane degrades locally, creating a vascular deformity and allowing new endothelial modeling. The tumor or macrophages may also secrete anti-angiogenesis agents such as angiostatin, endostatin, and thrombospondin.

4. Invasion

Tumor cells invade host stroma using enzymes, and then enter blood stream or lymphatics (which have thinner walls). The host reaction to this invasion is a fibrous ECM called the “desmoplastic response.”

5. Transport of cancer cells

Single cells or aggregates detach. Blood stream is very hostile to cancer cells, so aggregates survive better, and become trapped in microvasculature downstream. They adhere to endothelial cells or even the basement membrane and invade distant tissue. Growth factors supporting new cancer include transforming growth factor beta (TGF-β) and insulin-like growth factor-1 (IGF1). Tumor cells express chemokine receptors complementary to target organ chemokines and therefore chemokines influence patterns of spread between organs9.

FIGURE.1. Tumor development from initial carcinogenesis to diffusion limited   

Maximal size10

v) Causes: Cancer arises from one single cell. The transformation from a normal cell into a tumor cell is a multistage process, typically a progression from a pre-cancerous lesion to malignant tumors. These changes are the result of the interaction between a person's genetic factors and three categories of external agents, including:

• Physical carcinogens, such as ultraviolet and ionizing radiation.

• Chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminant).

• Biological carcinogens, such as infections from certain viruses, bacteria or parasites10

vi)  Clinical features-Symptoms

Cancer may affect people at all ages, even fetuses, but risk for the more common varieties trends to increase with age. Cancer causes about 13% of all deaths11. Roughly, cancer symptoms can be divided into three groups:

• Local symptoms: unusual lumps or swelling (tumor), hemorrhage, pain and/or ulceration.

• Symptoms of metastasis (spreading): enlarged lymph nodes, cough and hemoptysis, hepatomegaly, bone pain, fracture of affected bones and neurological symptoms. advanced cancer may cause pain.

• Systemic symptoms: Weight loss, poor appetite, fatigue and cachexia (wasting), excessive sweating (night sweats), anemia and specific paraneoplastic phenomena, i.e., specific conditions that are due to an active cancer, such as thrombosis or hormonal changes

Treatmet

The best form of treatment will be decided based on the type of cancer and how far it has progressed in the body. A combination of treatment

options could also be used if it is believed that it will help in the treatment process. Each person undergoing treatment must have a detailed discussion with their doctor(s) about treatment options applicable to her.

Some other forms of treatment are

Hormonetherapy
This treatment method adds, blocks, or removes hormones. For certain conditions (such as

diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. This method is sometimes also referred to as endocrine therapy.

Transplantation

Chemotherapy has become an integral component of cancer treatment for most cancers. Conventional chemotherapeutic agents still exhibit poor specificity in reaching tumor tissue and are often restricted by dose-limiting toxicity. The combination of developing controlled release technology and targeted drug delivery may provide a more efficient and less harmful solution to overcome the limitations found in conventional chemotherapy16. The efficacy of cancerous chemotherapy is often limited by serious side effects because of the toxicity of anticancer drugs to both tumor and normal cells38.

MATERIALS

                 Table.1 Materials used

Formulation and experimental methodology

Selection of drug:-  Anastrozole is used because of their  anti-cancer properties. Arimidex acts like an aromatase inhibitor, it aids in preventing cancer formation and development. This drug has inhibiting effects on body enzymes responsible for enzyme production. Most breast cancers require estrogen for forming and thus taking Arimidex can assist in slowing down the formation of these kinds of cancers. This reduces the chances of cancer diffusing to other body parts.

 This taking Arimidex over a long period is more effective than taking tamoxifen for a similar period. In fact, this is the best hormonal therapy option for postmenopausal women suffering from early stage breast cancer. In women who normally experience recurrence, Arimidex increases the period before cancer comes back. Furthermore, it also lessens the chances of another cancer forming in the non-affected breast.It acted through stopping the growth of the tumor (or) shrinking it.

Preformulation Studies

Preformulation is defined as phase of research and development process where physical, chemical and mechanical properties of new drug substances are characterized alone and when combined with excipient, in order to develop stable, safe and effective bioavailable dosage form.

Analytical Method

Anastrozole

100mg of Anastrozole was weighed and dissolved in methanol and made up to 100ml with methanol in a 100ml volumetric flask which gives 1000µg/ml of the solution. From the above solution 10ml of aliquot was pipetted out and made up to 100ml with methanol to give 100µg/ml of the solution. From this solution 0.5ml of aliquot was pipetted out and made upto 10ml with methanol to give 5µg/ml of the solution.

Preformulation studies for Anastrozole have been performed to know the drugs physicochemical properties so as to design it to a suitable formulation. Anastrozole is a class 2 drug classified under BCS classification with low solubility and high permeability. The physicochemical properties were described in the table  below;

Table: Preformulation studies of Anastrozole.     

Poor solubility leads to poor dissolution, therefore to enhance the dissolution of the drug, different techniques have been employed such as particle size reduction by forming nanoparticles which is a novel technique.

Standard calibration curve of Anastrozole.

Characterization of Nanoparticles

Particle size analysis by scanning electron microscope

Sem was used to determine the particle size of sample Anastrozole BSA +PEG 4000 nanoparticles.the avg size of formulation was found to be in nano range of 119nm to 319nm. Surface morphology and shape were visualized.The particles are appeared like  spears. From this study it has been concluded that there is a size reduction of particle which results  in enhancing dissolution rate of the anastrozole.

Percentage drug entrapment efficiency
Drug entrapment efficiency of Anastrozole nanoparticle formulations

In-vitro drug release studies:     

In-vitro drug release studies of anastrozole nanoparticles were performed under magnetic stirring for a month. The calibration curve of the drug was constructed to determine the concentration of the drug from the absorbance value. From this the % drug release was determined. The plots of cumulative percentage drug release v/s time for all the four formulations (F1, F2, F3, F4) were drawn and represented graphically as shown in the fig. The results of the in-vitro dissolution studies of formulation F1 to F4.

In-vitro drug release study of Anastrozole nanoparticles

Conclusion

Serum stable long circulating polymeric Anastrozole-BSA nanoparticles were successfully prepared by Desolvation technique. The control and sustained release of anastrozole nanoparticles were characterized by FT-IR,  DSC and surface morphology was characterized by scanning electron microscopy. They were evaluated drug loading, percentage entrapment efficiency, particle size, in vitro release rate studies. FT-IR studies showed that similar characteristic peaks appear with out  differences for the drug and their formulations; hence, it can be concluded that there was no chemical interaction between the drug and the polymer and drug was stable in the nanoparticles formulations. The DSC is done for the stability test for pure drug and formulation the thermogram of drug has not shifted for in the formulation compare to pure drug thermogram hence,the formulation stability is good. which revealed that drug is in amorphous state in the formulation. The surface morphology of Anastrozole- BSA nanoparticles was spherical in shape with smooth surface. The particles are observed aggregated might be due to the sticky nature of polymer. In particle size analysis, Anastrozole nanoparticles obtained comparatively nanosized particles range in between 150-400nm. The maximum drug loading and percentage entrapment efficiency was found to be 36% to 48%. Thus an effective Anastrozole-BSA nanoparticle was successfully developed using a desolvation technique.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad